Healthcare Provider Details

I. General information

NPI: 1679594212
Provider Name (Legal Business Name): KATE KATHLEEN MCDONALD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA KATHLEEN MCDONALD M.D.

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 GATEWAY DR
SLIDELL LA
70461-5591
US

IV. Provider business mailing address

380 GATEWAY DR
SLIDELL LA
70461-5591
US

V. Phone/Fax

Practice location:
  • Phone: 985-690-6600
  • Fax: 985-690-9860
Mailing address:
  • Phone: 985-690-6600
  • Fax: 985-690-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number16771
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD016771
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: